Novel virtual reality based training system for fine motor skills: Towards developing a robotic surgery training system

Abstract

Background: Training surgeons to use surgical robots are becoming part of surgical training curricula. We propose a novel method of training fine-motor skills such as Microscopic Selection Task (MST) for robot-assisted surgery using virtual reality (VR) with objective quantification of performance. We also introduce vibrotactile feedback (VTFB) to study its impact on training performance. Methods: We use a VR-based environment to perform MST with varying degrees of difficulties. Using a well-known human-computer interaction paradigm and incorporating VTFB, we quantify the performance: speed, precision and accuracy. Results: MST with VTFB showed statistically significant improvement in performance metrics leading to faster completion of MST with higher precision and accuracy compared to that without VTFB. Discussion: The addition of VTFB to VR-based training for robot-assisted surgeries may improve performance outcomes in real robotic surgery. VTFB, along with proposed performance metrics, can be used in training curricula for robot-assisted surgeries. K E Y W O R D S human-computer interaction, psychomotor, surgical robot, true positive rate, vibrotactile feedback 1 | INTRODUCTION Surgical robots are increasingly being used in almost every multispecialty hospital. Currently, they have multiple applications in pelvic, abdominal, select-chest and neurosurgical procedures. 1-6 The technology of surgical robots today has advanced sufficiently to provide a high degree of freedom in the robots' arm movements, control and stereoscopic vision. The improved user-interface of these technologies has led to better on-the-job performance and faster learning curves in the use of surgical robots such as da Vinci®, 7 ROSA® 8,9 and Senhance™. 10 Psychomotor skills play a vital role in surgical task performance with increased speed, accuracy, sensitivity and precision. Surgical robotic systems typically seek to help surgeons perform surgeries with higher accuracy, faster responses to intraoperative complications and increased dexterity. Quantification of psychomotor skills became essential with robotic surgical training systems that emphasize rare complex surgical scenarios, challenges and evaluations of these skills. Training and evaluation of these skills are crucial for effective analysis of the surgeons in the tasks as mentioned earlier. The evaluation of the performance is currently through cognitive, technical and non-technical skills. Technical skills (TS)

Utility and Usability of Two Forms of Supplemental Vibrotactile Kinesthetic Feedback for Enhancing Movement Accuracy and Efficiency in Goal-Directed Reaching

“…We envision a future where intelligent wearable technologies enhance functional movements by sensing the state of the body and its physical surroundings, synthesizing real-time sensory feedback optimized to achieve control goals, and delivering the feedback in an inconspicuous way that does not interfere with other critical behaviors. Recent advances in wearable sensors and computing have made possible the development of novel augmentation technologies that have potential applications in a wide array of fields, including aerospace [ 20 , 21 ], navigation [ 22 ], virtual reality [ 23 ], sports [ 24 , 25 ], and healthcare [ 26 , 27 ]. In healthy individuals, supplemental feedback has been used to augment motor performance in complex tasks, such as robot-assisted surgery [ 28 , 29 , 30 ], and to promote motor learning while playing an instrument or sports [ 31 , 32 , 33 ].…”

Integration of Virtual Reality in the Control System of an Innovative Medical Robot for Single-Incision Laparoscopic Surgery

“…The second training approach is a relatively new technique that uses VR to create simulators for robotic surgical training as a method to improve the robotic assisted surgical skills; it is derived from the gaming industry and with the technological progress it is now able to encompass high detail environments, relevant for advanced training programs. Furthermore, by using VR simulators, modifiable levels of difficulty and challenges can be used, where surgeons can also learn to manage unpredictable events [ 6 ]. Thus, these simulators are able to properly train surgeons before entering the operating room and working with patients.…”

Kinematic coordinations capture learning during human–exoskeleton interaction

“…However, dynamic behaviors that are representative of day-to-day motor learning and neurorehabilitation have received less attention 18 , 19 , and even fewer studies consider dynamic interactions between a human and an exoskeleton 20 – 22 . Dynamic task studies use “extrinsic” performance metrics such as task success or accuracy 23 – 25 , which are easy to measure and accurately represent the effect of human movement on task outcome. But these metrics fail to capture the underlying neuromuscular behavior that affects the performance.…”